In case of emergency...

Yesterday, I went to speak to a group at the German Chamber of Commerce.  I haven’t seen that many blonde people in one room I was last in Iowa, but these were notably svelter, and with sharper glasses.  I was there to tell them what to do in case an emergency befell them in China. 

Because I’m an ER doctor, you can kind of see why they would think I would be a good person to give this talk.  But the logic doesn’t really hold up: I have literally never witnessed an emergency outside of the ER.  Well, unless you count the lady I saw lying in the street last month, just after she’d been hit by a car.  But at that time, I did exactly what the untrained bystanders were doing--told her to hold still and waited for the ambulance.  When they arrived I was able to provide a little information for them, since she spoke only Spanish and they didn’t, but let’s face it--they could have gotten her on a gurney without knowing how old she was and that she had hypertension and diabetes.  If she had been gushing blood and in cardiac arrest with low blood sugar, I couldn’t have done much more before the EMT’s arrival, certainly nothing more than anyone who has taken a CPR class is trained to do.  The fact is that, without our equipment, doctors are about as much use in emergency as a pathology textbook, and possibly less so, since you might at least be able to use the book to fashion a splint. 

But at any rate, the MD and my job give me a bit of credibility, and so, despite the fact that I haven’t done any of these things, I told them to:  get a first aid kit, make a phone list, get to know the neighbors, take a CPR class, know where the closest local hospital is in case you have a true life-threatening emergency and live on the far side of town (otherwise, of course, come visit us and our fresh-faced English-speaking staff at the hospital whose logo was prominently displayed in the mandated PowerPoint template I was using), think hard about whether an ambulance will really add much to their transport over a taxi, and keep a wad of cash around. 

It was, of course, the last two that got the group going.  Regarding the cash, they asked the next logical question about quantity.  I found it both impolitic and imprecise to answer “as much as you can afford to lose,” and punted to my boss, there at my side wearing his own slick glasses.  “Around 20,000 RMB” he said, without missing a beat.  That’s about $3000, and seemed as good a guess as any, until I started trying to imagine actually taking three thousand of my own dollars out of commission and leaving them on a shelf (or as he suggested, in a safe purchased for this sole purpose) in my house just in case some day someone in the family has such a severe and sudden illness that no one is able to get to the ATM.  I then tried to imagine scrambling to recall the combination to said safe, likely having gathered several years’ worth of dust by then, during that same emergency.  The Germans twisted the knife by asking, if they were to go sight-seeing to another area of China, were they really supposed to carry that kind of cash with them?  Which, I think, is the point when the intrinsic silliness of an American ER doctor answering such questions hit us all, and I moved on to the next imponderable.

One of the first things you notice after you move here is the tremendous amount of honking.   Chinese people seem to consider honking a mandatory part of driving, like checking your rear-view mirrors or using your turn signal, and they do it with the same regularity recommended for those commendable habits.  The second thing you notice is the lack of sirens amid the cacophony.  I don’t think I’ve heard a police, ambulance, or fire siren out my window in the entire time I’ve been here.  And I’d notice if there were, since it would be there for a while--the drivers in a typical Shanghai traffic snarl would be unlikely to be able to pull over, even if they were inclined to. 

Shanghai does have ambulances, though, and each one is supposed to be manned with a driver, a technician, and a doctor, which would make them apparently--if not in fact-- better staffed than US ambulances, as ours don’t generally carry doctors.  It wouldn’t, however, make them better-staffed than German ambulances, which all have doctors.  And all doctors are not created equal.  When I graduated medical school, I was technically a “doctor.”  I had done a full undergraduate degree and a full course of medical school, and had MD after my name.  But you wouldn’t have wanted me riding along in your ambulance, directing your resuscitative care.  It took another year of residency training before I was even licensed to prescribe drugs, and three more after that before I was released into the world to practice on my own.  In Germany it’s roughly the same. 

In China, however, high school graduates go to university for five years, and then they’re doctors.  Sure, they have to go work at a hospital for one to three years after that, which period sort of resembles a western residency program (or, more accurately, half of one), but from what I hear, the new graduates need to apprentice themselves directly to someone at that hospital, constantly demand that person’s attention, and learn to do things exactly that person’s way.  There is no formal curriculum, and no testing along the way until the very end, when they sit a licensing examination.  So even if it’s not until then that newly-minted doctors are allowed to staff an ambulance, if one were to happen to call one, and it actually arrived, you’d likely to be facing a worn-out kid familiar with only one way of doing things, manning a possibly ill-equipped van whose arrival-time was as dependent on the vagaries of traffic as any other vehicle’s.  Whereas, outside many of the compounds the expats live in, there is a line of seasoned taxi drivers waiting to whisk you away, any one of whom may actually know the quickest route to the nearest hospital. 

This puts anyone requiring transport to the hospital on the horns of a genuine dilemma.  The Germans asked me which to choose, but my time was almost up, and I was done pretending to have the answers, so I have them the same look I gave the Princess recently, when she asked me if she should choose the Barbie backpack or the anime girls one.  It’s my “You’re on your own, kiddo!” one, which has never been greeted with anything but head-shaking amazement at my unhelpfulness.  This was no exception.